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Nurse Care Manager I/Nurse Care Manager II (Job Family)

Location: MI
JobFamily: Medical
Req #: PS66580
Date Posted: Jan 23, 2022

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Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

Given Anthem’s scale, balance sheet, broad national reach and depth at the local market level, Anthem has established a new business unit called the Diversified Business Group. The Diversified Business Group is a solutions-oriented business unit within the Company that will support Anthem and other external clients in the pursuit of transforming healthcare.

Location: Remote (Must have an RN Compact State License and/or single RN License in the state of Ohio or Michigan)

Hours:  11:30 am - 8:00 pm EST 

Sign-On Bonus: $2,000

Nurse Care Manager I or II  (Job Family) *
Associates in this job are paid hourly and are eligible for overtime.

*Please note: This position may be filled at either the Nurse Care Manager I or II. 
The Hiring Manager will determine the level based upon the selected applicant's skillset relative to the qualifications listed for this position. 
 

Job Summary - Nurse Care Manager I and II
Responsible for collaborating with healthcare providers and/or consumers to drive personalized health management and improve health outcomes for optimal consumers. Performs care management activities within the scope of licensure for members with complex and chronic care needs. 

Nurse Care Manager I, II Primary duties may include, but are not limited to: 

  • Ensures medically appropriate, high quality, cost-effective care through assessing the medical necessity of inpatient admissions and extensions of stay, outpatient services, out-of-network services, and appropriateness of treatment setting and level of care. 
  • Partners with physician clinical reviewers and/or medical directors to interpret the appropriateness of care, intervention planning, and general clinical guidance. 
  • Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge. 
  • Conducts clinical assessment to develop goals that address individual needs in order to develop and implement a care plan.
  • Monitors and evaluates the effectiveness of the care management plan and modifies as necessary. 
  • Coordinates a care plan*
  • Assists with the development of utilization/care management policies and procedures. *
  • Participates in or leads intradepartmental teams, projects, and initiatives. *

(*Nurse Care Manager II additional duties)



We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
 

Qualifications

Required Qualifications Nurse Manager I :

  • Requires minimum of 3 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience and a minimum of 1 year in a Nurse Care Mgr I role or equivalent experience; or any combination of education and experience, which would provide an equivalent background.
  • Current, unrestricted RN license in applicable state(s) required. Multi-state licensure is required if this individual is providing services in multiple states.

Preferred Qualifications Nurse Care Manager I: 

  • AS or BS in nursing preferred.
  • Certification as a Case Manager or a BS in a health or human services related field, also preferred.
  • Participation in the American Association of Managed Care Nurses preferred.
  • Prior managed care experience preferred.
  • Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred.

Required Qualifications Nurse Care Manager II:

  • Requires minimum of 3 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience and a minimum of 1 year in a Nurse Care Mgr I role or equivalent experience; or any combination of education and experience, which would provide an equivalent background.
  • Current, unrestricted RN license in applicable state(s) required.
  • Multi-state licensure is required if this individual is providing services in multiple states.

Preferred Qualifications Nurse Care Manager II:

  • AS or BS in nursing preferred.
  • Certification as a Case Manager is preferred. Participation in the American Association of Managed Care Nurses preferred.
  • Prior managed care experience preferred.
  • Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.

Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.